Provider Demographics
NPI:1770997827
Name:DITTMER, JOLENE LOREE (LPNC)
Entity type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:LOREE
Last Name:DITTMER
Suffix:
Gender:F
Credentials:LPNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12849 A RD
Mailing Address - Street 2:
Mailing Address - City:CLARKS
Mailing Address - State:NE
Mailing Address - Zip Code:68628-6001
Mailing Address - Country:US
Mailing Address - Phone:308-548-8114
Mailing Address - Fax:
Practice Address - Street 1:1715 26TH ST
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:NE
Practice Address - Zip Code:68826-9501
Practice Address - Country:US
Practice Address - Phone:308-946-3015
Practice Address - Fax:308-946-5914
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6675164W00000X
NE465164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse